中国教学医院急诊医生心肺复苏时的通气策略现状调查
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摘要
目的:调查目前国内教学医院急救人员心肺复苏时的通气策略现状,为下一步规范急救人员心肺复苏时的通气策略提供依据。方法:随机对国内400家教学医院的急救人员展开问卷调查,分别收集医院信息、医生信息以及所在医院心肺复苏时的通气策略现状。结果:385家医院的填写信息完整,囊括了我国所有的省、自治区、直辖市、特别行政区(中国台湾和香港除外)。其中接受过美国心脏协会(AHA)心肺复苏指南培训的占26.5%,接受过欧洲心肺复苏指南培训的占2.3%,剩余的接受过国内心肺复苏培训。其中43%的受访者选择了在心肺复苏时延迟通气或不通气,其中延迟通气者延迟时间都在12 min内。在所有给予通气的受访者中,有85.6%选择严格遵守302的策略,而14.4%选择协同通气、不中断按压。只有37.1%的受访者选择有指征时插管,而62.9%选择复苏时立即插管。50.1%的受访者所在团队能在2min内完成插管,29.6%的受访者所在团队插管时按压耽误的时间<5s,立即气管插管组和指征气管插管组在插管时间和按压耽误的时间上均差异有统计学意义(P<0.01)。球囊通气时,只有52.0%的受访者能保证10次/min的通气频率。上呼吸机时,74.8%的受访者会选择VC,73.4%会选择6～8ml/kg,69.1%选择0或0～5cmH_2O的PEEP,68.1%选择给予纯氧。然而60.6%的受访者设置呼吸机后常常有误触发,51.1%常常有高压报警。结论:目前对于心肺复苏患者的通气问题,国内各家教学医院实施情况差异巨大,需要指南对心肺复苏的通气做出具体推荐、加强相关细节的培训尤其是呼吸机设置相关的培训。
Objective:To investigate the current status of ventilation strategies in cardiopulmonary resuscitation(CPR)among first aid personnel in teaching hospitals in China,and to provide evidence for standardizing the ventilation strategies in CPR.Method:A questionnaire survey was conducted to first-aid staff of 400 teaching hospitals in China.Hospital information,doctor information and ventilation strategy during CPR were collected.Result:Firstaid staff of 385 hospitals completed the survey.The hospitals distributed in all provincial-level administrative units of China,except Hong Kong and Taiwan.Among them,26.5% had received AHA CPR guidelines training from the United States,2.3% had received European CPR guidelines training,and the rest had received domestic CPR training.43% of the respondents chose delayed or inactive ventilation during CPR,and delayed ventilation were all performed within 12 minutes.Of all the respondents who gave ventilation,85.6% strictly followed the 30 2 strategy,while the other 14.4% performed cooperative ventilation and uninterrupted compression.Only 37.1%respondents intubated when indicated,while the other 62.9%intubated immediately when resuscitate began.50.1%of the respondents were able to complete intubation within 2 minutes,29.6%of the respondents can intubate with compression delays of less than 5 seconds.There were significant differences in intubation time and compression delays time between the immediate tracheal intubation group and the indicated tracheal intubation group(P <0.05).During bagmask ventilation,only 52.0% of the respondents could guarantee the frequency of 10 times/minute.74.8% of the respondents chose VC,73.4%chose 6-8 ml/kg,69.1%chose 0-5 cm H_2 O PEEP,and 68.1%chose pure oxygen.However,60.6% of the respondents often had false triggers after setting ventilator,and 51.1%often had high pressure alarm.Conclusion:At present,there are great differences in ventilating the patient during CPR in teaching hospitals in China.Guidelines are needed to make specific recommendations on the ventilation of CPR,and to strengthen the training of relevant details,especially the training of ventilator settings.
Objective:To investigate the current status of ventilation strategies in cardiopulmonary resuscitation(CPR)among first aid personnel in teaching hospitals in China,and to provide evidence for standardizing the ventilation strategies in CPR.Method:A questionnaire survey was conducted to first-aid staff of 400 teaching hospitals in China.Hospital information,doctor information and ventilation strategy during CPR were collected.Result:Firstaid staff of 385 hospitals completed the survey.The hospitals distributed in all provincial-level administrative units of China,except Hong Kong and Taiwan.Among them,26.5% had received AHA CPR guidelines training from the United States,2.3% had received European CPR guidelines training,and the rest had received domestic CPR training.43% of the respondents chose delayed or inactive ventilation during CPR,and delayed ventilation were all performed within 12 minutes.Of all the respondents who gave ventilation,85.6% strictly followed the 30 2 strategy,while the other 14.4% performed cooperative ventilation and uninterrupted compression.Only 37.1%respondents intubated when indicated,while the other 62.9%intubated immediately when resuscitate began.50.1%of the respondents were able to complete intubation within 2 minutes,29.6%of the respondents can intubate with compression delays of less than 5 seconds.There were significant differences in intubation time and compression delays time between the immediate tracheal intubation group and the indicated tracheal intubation group(P <0.05).During bagmask ventilation,only 52.0% of the respondents could guarantee the frequency of 10 times/minute.74.8% of the respondents chose VC,73.4%chose 6-8 ml/kg,69.1%chose 0-5 cm H_2 O PEEP,and 68.1%chose pure oxygen.However,60.6% of the respondents often had false triggers after setting ventilator,and 51.1%often had high pressure alarm.Conclusion:At present,there are great differences in ventilating the patient during CPR in teaching hospitals in China.Guidelines are needed to make specific recommendations on the ventilation of CPR,and to strengthen the training of relevant details,especially the training of ventilator settings.
引文
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[15] McInnes AD,Sutton RM,Orioles A,et al.The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents[J].Resuscitation,2011,82(8):1025-1029.
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[17]Cordioli RL,Lyazidi A,Rey N,et al.Impact of ventilation strategies during chest compression.An experimental study with clinical observations[J].J Appl Physiol(1985),2016,120(2):196-203.
[18]Kilgannon JH,Jones AE,Parrillo JE,et al.Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest[J].Circulation,2011,123(23):2717-2722.
[19]Bellomo R,Bailey M,Eastwood GM,et al.Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest[J].Crit Care,2011,15(2):R90.
[2] Cordioli RL,Brochard L,Suppan L,et al.How Ventilation Is Delivered During Cardiopulmonary Resuscitation:An International Survey[J].Respir Care,2018,63(10):1293-1301.
[3] Deakin CD,O'Neill JF,Tabor T.Does compressiononly cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest?[J].Resuscitation,2007,75(1):53-59.
[4] Safar P,Brown TC,Holtey WJ,et al.Ventilation and circulation with closed-chest cardiac massage in man[J].JAMA,1961,176:574-576.
[5] Roosa J,Kiamura B,McCarty K,et al.SHARE Study Group.Does chest compression-only CPR provide meaningful gas exchange in humans?[J].Circulation,2012,126(Suppl):A281.
[6] Brochard L,Mion G,Isabey D,et al.Constant-flow insufflation prevents arterial oxygen desaturation during endotracheal suctioning[J].Am Rev Respir Dis,1991,144:395-400.
[7]Wang S,Li C,Ji X,et al.Effect of continuous compression and 30:2cardiopulmonary resuscitation on global ventilation/perfusion values during resuscitation in a porcine model[J].Crit Care Med,2010,38(10):2024-2554.
[8] Nichol G,Leroux B,Wang H,et al.Trial of continuous or interrupted chest compressions during CPR[J].N Engl J Med,2015,373(23):2203-2214.
[9] Monsieurs KG,Nolan JP,Bossaert LL,et al.European Resuscitation Council Guidelines for Resuscitation2015:Section 1.Executive summary[J].Resuscitation,2015,95:1-80.
[10]Benoit JL,Gerecht RB,Steuerwald MT,et al.Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest:A meta-analysis[J].Resuscitation,2015,93:20-26.
[11]Fouche PF,Simpson PM,Bendall J,et al.Airways in out-of-hospital cardiac arrest:systematic review and meta-analysis[J].Prehosp Emerg Care,2014,18(2):244-256.
[12]Andersen LW,Granfeldt A,Callaway CW,et al.Association Between Tracheal Intubation During Adult InHospital Cardiac Arrest and Survival[J].JAMA,2017,317(5):494-506.
[13]Soar J,Nolan JP,B9ttiger BW,et al.European Resuscitation Council Guidelines for Resuscitation 2015:Section 3.Adult advanced life support[J].Resuscitation,2015,95:100-147.
[14]Vissers G,Soar J,Monsieurs KG.Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation:A systematic review[J].Resuscitation,2017,119:5-12.
[15] McInnes AD,Sutton RM,Orioles A,et al.The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents[J].Resuscitation,2011,82(8):1025-1029.
[16]Ruemmler R,Ziebart A,Moellmann C,et al.Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation[J].Resuscitation,2018,132:56-62.
[17]Cordioli RL,Lyazidi A,Rey N,et al.Impact of ventilation strategies during chest compression.An experimental study with clinical observations[J].J Appl Physiol(1985),2016,120(2):196-203.
[18]Kilgannon JH,Jones AE,Parrillo JE,et al.Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest[J].Circulation,2011,123(23):2717-2722.
[19]Bellomo R,Bailey M,Eastwood GM,et al.Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest[J].Crit Care,2011,15(2):R90.